Transposition of the great arteries is a common form of cyanotic congenital heart disease that without intervention has a 90% mortality rate within the first year of life. In the past, surgical options were limited to physiologic correction at the atrial level, but long-term follow-up has revealed problems with right ventricular dysfunction, tricuspid valve insufficiency, arrhythmias, and venous obstruction. This has renewed an interest in the arterial switch as an early, definitive form of anatomic correction for infants with transposition. As selection criteria have been refined, the mortality rate at experienced centers now equals that of physiologic correction. Nursing care centers around the critically ill neonate who may have hypotension and low cardiac output because of a poorly adapted left ventricle. Assessment for potential myocardial infarction resulting from movement and reimplantation of the coronary arteries is essential.